Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item A Composite symptom score using frequency and severity correlates better to an objective measure of Gastro-Oesophageal Reflux Disease (GERD) than one scoring frequency of symptoms alone(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2008) Amarasiri, L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, H.J.INTRODUCTION: The prevalence of GERD is increasing. Community prevalence in Sri Lanka is unknown. There is lack of a practical screening instrument to use in an epidemiological setting. OBJECTIVE : To develop a practical clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlated better with an objective measure of GERD than one using only symptom frequency. METHODOLOGY: A cross-sectional validity study was performed in 100 GERD patients and 150 healthy controls comparable in age and gender. Ethical clearance was granted. GERD was diagnosed by upper gastro-intestinal endoscopy, including patients with all grades of oesophagitis. All subjects faced a GERD-specific interviewer-administered questionnaire with seven upper gastro-intestinal symptoms (heartburn, acid regurgitation, chest/abdominal pain, abdominal distension, dysphagia, cough, belching). Each symptom was graded using a 5-item Likert scale for frequency (never, monthly, 2-4 times per week, weekly, daily) and a 4-item scale for severity (no effect, mild, moderate, severe) and two scores generated. Score 1 being the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each symptom. All GERD patients underwent 24h ambulatory pH monitoring. Face and content validity were assessed by expert consultation and literature review, internal consistency by Cronbach alpha statistics, reliability by intra class correlation coefficient estimation and concurrent validity by comparison of scores with 24 hour pH monitoring values as the gold standard. Cut-off values were determined by constructing receiver-operating characteristic curves. RESULTS: For both scores, mean scores of cases were significantly higher than controls (p<0.001) Cut-off score for score 1 was ≥ 10.50 (sensitivity 92.0%; specificity 78.7%; area under the curve 0.937 respectively). Cut-off score for score 2 was ≥ 12.50 (sensitivity 90.0%; specificity 78.0%; area under the curve 0.929 respectively). Intra class correlation coefficient for score 1 and 2 were 0.94 and 0.82 respectively. There was good correlation between both symptom scores and 24-h pH metry parameters (Spearman rank correlation, p=0.01), but score 2 showed a significantly better correlation (correlation of Total reflux time pH<4 with score 1 and score 2 was 0.491 and 0.651; p=0.001, and of Demeester score with score 1 and score 1 was 0.590 and 0.747; p<0.001). CONCLUSION: Our GERD questionnaire is valid, reliable and showed better correlation with an objective test when both severity and frequency of symptoms were scored rather than frequency of symptoms alone.Item The Prevalence of reflux oesophagitis in adult asthmatics(Wiley- Blackwell, 2009) Amarasiri, L.; Ranasinha, C.D.; de Silva, H.J.BACKGROUND/PURPOSE: Asthma and gastro-oesophageal reflux disease are known to be associated. The severity of asthma is related to the degree of reflux. This relationship has been little studied in South Asia. METHODS: Thirty asthmatics underwent a reflux symptom assessment using a validated questionnaire assessing 7 upper gastro-intestinal (UGI) symptoms graded on a 5-point Likert scale (Amarasiri LD 2009). They further underwent UGI endoscopy. RESULTS: All asthmatics had mild stable asthma. 20 of the 30 asthmatics had apositive GORD symptom score. 27 asthmatics consented to UGI endoscopy. The grade of oesophagitis was classified using Savary Miller criteria. 10 of the 27 asthmatics had evidence of mucosal damage (see Table 1). There was no correlation between the grade of oesophagitis and the GORD score (r = 0.025; P = 0.896, Spearman Rank correlation). CONCLUSIONS: The prevalence of reflux oesophagitis in asthmatics was 37%. There was no association of severity of oesophagitis with symptoms. Both these findings are consistent with the global data, but have not previously been described in a South Asian population.Item The prevalence of upper respiratory symptoms in a cohort of adults presenting with symptoms of gastro-oesophageal reflux disease(Sri Lanka Medical Association, 2016) Amarasiri, D.L.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Adikari, M.D.B.; Sanjeewa, P.A.B.; Jayaratne, A.; de Silva, H.J.INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is the pathological reflux of gastric contents into the oesophagus. The oesophagus and the upper respiratory tract have a common origin from the foregut. There is increasing evidence for multiple associations of GORD with the upper respiratory tract. OBJECTIVES: To study the presence of and association of upper respiratory symptoms (URS) with GORD. METHODS: Seventy adults scoring ≥12.5 on a previously validated GORD symptom score (GORD patients) and 70 healthy controls who had infrequent GORD symptoms or no upper gastro-intestinal complaints completed a pre-tested URS questionnaire on the frequency of 14 URS in 5 categories (laryngeal, nasal, pharyngeal, sinusal and aural). All GORD patients underwent upper gastro-intestinal endoscopy. The calculated URS score was correlated against the GORD symptom score and endoscopy findings. RESULTS: URS scores and individual symptom scores were higher in GORD patients compared to controls (mean ± SE, 4.7 ± 4.0; 1.9 ± 2.3). Individuals with higher GORD symptom scores reported more frequent URS. Pharyngeal symptoms had the highest correlation with the GORD symptom score (r=0.507, p<0.001). The presence of oeso-phagitis did not seem to influence the frequency of reporting URS. CONCLUSION: Upper respiratory symptoms are common in individuals with GORD symptoms though there appears to be no association with oesophageal mucosal damage.Item Validation of a clinical scoring system to detect gastro-oesophageal reflux disease (GERD) in epidemiological surveys(Wiley Blackwell Scientific Publications, 2006) Amarasiri, L; Pathmeswaran, A.; Ranasinghe, C.; de Silva, H.J.BACKGROUND: The prevalence of GERD is increasing worldwide. Community prevalence in Sri Lanka is unknown. OBJECTIVES: To develop a clinical score to screen for GERD in the community and assess whether a score using symptom frequency and severity correlates better to an objective measure of GERD than one using only symptom frequency. METHODS: A cross-sectional validity study carried out on 72 patients (endoscopy positive) and 75 controls (comparable in age and gender). All faced a GERD-specific interviewer-administered questionnaire assessing seven upper gastro-intestinal symptoms, each graded for frequency (4- items) and severity (5-items). Two scores were generated. Score 1: sum of frequency of symptoms and score 2: sum of products of frequency and severity of each symptom. All patients underwent 24 h pH-metry. Validity established by correlating symptom scores with 24 h pH-metry parameters. Cut-off values determined by receiver-operating characteristic curves. RESULTS: Mean scores of cases were significantly higher than controls (p < 0.001). Cut-off score for score 1 was ≥11.50 (sensitivity 91.7%, speci- ficity 82.7%, positive and negative predictive values 70.0% and 95.9%). Cut-off score for score 2 was ≥14.50 (sensitivity 94.4%, specificity 78.7%, positive and negative predictive values 66.0% and 97.0%). Both scores showed high reproducibility (intra-class correlation coefficient of score 1 = 0.95 and score 2 = 0.89). There was good correlation between symptom scores and 24-h pH parameters (Spearman rank correlation, p = 0.01), but score 2 showed a significantly better correlation. CONCLUSIONS: Our GERD questionnaire is valid, reproducible, with better correlation with an objective test when both severity and frequency of symptoms were scoredItem Upper respiratory symptoms are common in a cohort of patients with symptomatic gastrooesophageal reflux disease (GORD) in Sri Lanka(Wiley Blackwell Scientific Publications, 2011) Amarasiri, D.L.; Adikari, D.; Sanjeewa, B.; Jayaratne, A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.INTRODUCTION: There is increasing evidence for multiple associations between gastro-oesophageal reflux disease (GORD) and the upper respiratory tract. This study evaluated the presence of upper respiratory symptoms (URS) in a cohort of patients with GORD symptoms from Sri Lanka. METHOD: Seventy adults scoring ≥12.5 on a previously validated GORD symptom score (GORD patients) and 70 healthy controls who had infrequent or no GORD symptoms completed a pre-tested, valid URS questionnaire. They were questioned on frequency of 14 URS in 5 categories (laryngeal, nasal, pharyngeal, sinusal and aural). All GORD patients underwent gastroscopy. An URS score was calculated and correlated against the GORD symptom score and gastroscopy fi ndings. RESULTS : The GORD patients (median age (range) 36 (15–65); 38% males) and controls (median age (range) 38 (15–68); 38% males) were comparable. URS scores were higher in GORD patients (mean ± SE, 4.7 ± 4.0) compared to controls (mean ± SE, 1.9 ± 2.3), as were individual symptom scores. Individuals with higher GORD symptoms scores reported more frequent URS. Nasal symptoms had the highest correlation with the GORD symptom score (r = 0.410; P = 0.001). of the GORD patients, 42 had no evidence of oesophageal or gastric mucosal damage. 28 had evidence of refl ux oesophagitis. In them, the presence of oesophagitis did not seem to influence the frequency of reporting URS. CONCLUSION : URS are common in individuals with GORD symptoms though there appears to be no association with oesophageal mucosal damageItem Validation of a gastro-oesophageal reflux disease (GERD) specific screening instrument for epidemiological purposes(Sri Lanka Medical Association, 2006) Amarasiri, W.A.D.L.; Ranasinghe, C.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION: The prevalence of GERD is increasing worldwide; its community prevalence in Sri Lanka is unknown. AIMS: To develop a clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlates better to an objective measure of GERD than one using only symptom frequency. METHODOLOGY: 58 GERD patients (endoscopy positive) and 60 controls (matched for age and gender) were given a GERD-specific interviewer-administered questionnaire assessing seven upper gastrointestinal symptoms. Each symptom was graded using Likert scales for frequency (4-items) and severity (5-items), and two scores were generated. Score 1 was the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each symptom. The patients then underwent oesophageal manometry and 24h pHmetry. Cut-off values were determined by constructing receiver-operating characteristic curves. RESULTS: For both scoring systems, mean scores of cases were significantly higher than controls (p=0.000). The cut-off for score 1 was > 11.50 (sensitivity 91.4%, specificity 85%, positive and negative predictive values 83.29% and 92.34%). The cut-off for score 2 was > 12.50 (sensitivity 96.6%, specificity 80%, positive and negative predictive values 81.06% and 92.32%). Both scores showed high reproducibility (intra class correlation coefficient scorel=0.94 and score 2=0.82). There was good correlation between both scores and 24-h pH parameters (Spearman rank correlation, p=0.01), but score 2 was significantly better. CONCLUSION: Our GERD questionnaire is valid, reproducible and showed better correlation with an objective test when both severity and frequency of symptoms were scored rather than frequency alone.Item Peristaltic dysfunction in asthma is secondary to increased Gastro-Oesophageal Reflux(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2010) Amarasiri, L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.BACKGROUND: Vagal dysfunction and prolonged intra-oesophageal acidification cause oesophageal hypomotility. Asthmatics have ineffective oesophageal motility, but demonstrate increased vagal activity. Whether oesophageal hypomotility in asthmatics is a primary abnormality or secondary to pathological gastro-oesophageal reflux is unclear. Our aim was to investigate the relationship of oesophageal motility and gastro-oesophageal reflux (GOR)to vagal function in asthmatics. METHODS: Thirty consecutive mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory dual-sensor oesophageal monitoring, stationary oesophageal manometry and autonomic function testing. They also underwent gastro-oesophageal reflux disease (GORD) symptom assessment. Twenty seven of the thirty asthmatics underwent gastroscopy. A parasympathetic autonomic function score was calculated from vagal function tests (valsalva manouvre, heart rate variation to deep breathing, heart rate and blood pressure response to standing from a supine position) and correlated with gastro-oesophageal function parameters. RESULTS: Age and sex of asthmatics (mean age(SD), 34.8 years (8.4); 60% female) and controls (mean age(SD), 30.9 years (7.7); 50% female) were comparable. Asthmatics had a higher frequency and severity of GORD symptoms and 10/27 (39%) had oesophageal mucosal damage. Twenty two (69%) asthmatics showed a hypervagal response and none had a hyperadrenergic response. Manometrically, LOS and UOS parameters were similar in the two groups, but 14 asthmatics had ineffective oesophageal motility. Asthmatics with higher GORD symptom scores had a significantly lower percentage of peristaltic contractions and a higher percentage of simultaneous contractions than controls. They also had higher total and upright oesophageal acid contact times in the proximal oesophagus than those with low symptom scores. All reflux parameters were significantly higher in asthmatics. Twenty (66.7%) asthmatics had abnormal distal acid reflux and 22 (73.3%) had abnormal proximal acid reflux. Asthmatics also had significantly prolonged proximal and distal acid clearance times than controls. There was no association between parasympathetic function and either oesophageal motility or reflux parameters. CONCLUSIONS: Asthmatics with mild, stable asthma have abnormal oesophageal motility and pathological GOR. The asthmatics did not show any evidence of vagal dysfunction nor did the vagal function score correlate with oesophageal motility parameters. It seems likely that the peristaltic dysfunction is secondary to damage due to GOR and not primary vagal dysfunction.